March 8, 2010 (Miami Beach, Fla.) -- If the drug
Enbrel stops working, people
with psoriasis have two effective options, new research suggests.

One new study shows that the recently approved drug
Stelara can help treat
moderate to severe psoriasis if Enbrel fails.

A second study suggests Remicade is effective for people with psoriasis who
are no longer helped by Enbrel.

The findings were presented at the annual meeting of the American Academy of
Dermatology. Both studies were sponsored by Centocor, which makes Stelara and
Remicade.

About 7.5 million Americans suffer from psoriasis, a lifelong disorder
characterized by inflammation of skin and, often, the joints.

Stelara, Remicade, and Enbrel are all biologics -- drugs made of genetically
engineered proteins -- that are generally used to treat patients who aren't
responding to traditional therapies such as light therapy and methotrexate.

Remicade and Enbrel both block tumor necrosis factor-alpha (TNF-alpha), a
chemical produced by immune cells that fuels inflammation, much like gas on a
fire. Stelara targets two proteins, interleukin 12 and interleukin 23, that also
drive the inflammatory process.

The new findings show that if Enbrel stops working, "there are other
effective options," says Alan Menter, MD, chair of the psoriasis research unit
at Baylor Research Institute in Dallas.

Menter was an investigator in the Stelara study, a follow-up analysis of a
larger trial of more than 900 patients that showed Stelara was more effective
than Enbrel in the treatment of moderate-to-severe plaque psoriasis.

Comparing Psoriasis Treatments

The new analysis focused on 50 patients who continued to have
moderate-to-severe psoriasis after 12 weeks of Enbrel therapy. Compared with
people who were helped by Enbrel, they tended to be heavier, male, and have more
severe psoriasis.

All were given Stelara injections four weeks and eight weeks later.

Three months later, 40% had, at most, minimal signs of their psoriasis; 70%
had mild disease at most.

The second study involved 217 psoriasis patients who had significant disease
despite ongoing treatment with Enbrel. All were switched to Remicade therapy.

"While both drugs block TNF-alpha, they do so in slightly different ways.
There are subtle difference that made us think that Remicade may work more
effectively," says Robert Kalb, MD, a clinical professor of dermatology at the
State University of New York, Buffalo, who was involved in the trial.

By 10 weeks later, two-thirds had, at most, minimal disease.

So if you fail Enbrel, how do you decide whether to try Remicade or Stelara?

There has been no head-to head comparison, but generally Stelara is reserved
for people with more severe disease, Menter notes.

"Once on it, the vast majority of patients maintain improvement over the
course of the next few years," he adds.

If the patient's joints are inflamed, "I may be more likely to use a
TNF-alpha blocker," which have been used to treat arthritis for over a decade,
Menter says. (A study looking at the effects of Stelara on joint inflammation is
just starting.)

In general, the safety of all three drugs has been similar in various
studies, he says.

But Stelara has not been around long enough for researchers to know if it
will increase the risk for infections or cancer, known risks of biologic agents
that affect the body's immune system, says past American Academy of Dermatology
president Darrell S. Rigel, MD, clinical professor of dermatology at New York
University Medical Center.

The bottom line, he tells WebMD, is that many psoriasis patients have been
helped by Enbrel for psoriasis.

"If it doesn't work well or stops working, [Stelara and Remicade] are very
good drugs to consider. But if a drug is working, I would stay on it," he says.